甲状腺癌声像图特征分析及钙化在甲状腺癌诊断中的价值

发布时间：2018-06-24 02:23

本文选题：甲状腺癌 + 超声诊断　；参考：《苏州大学》2014年硕士论文

【摘要】：背景近年来甲状腺癌发病率呈逐年上升的趋势，是最常见的内分泌肿瘤，目前已成为女性最常见的恶性肿瘤；甲状腺癌约占全身恶性肿瘤的1%~2%，临床发现的甲状腺结节中有5％～10％为甲状腺癌。分化型甲状腺癌占所有甲状腺癌的90%，包括甲状腺乳头状癌（PTC）和滤泡癌。近几年来，从我国统计资料表明PTC发病率呈逐年上升趋势。因此，对甲状腺结节的鉴别诊断是临床关注的一个重点问题。目前，甲状腺疾病的检查方法很多，影像学检查主要包括超声检查、核素扫描、CT、核磁共振显像，各种方法都有其各自的优缺点。近年来，随着超声显像技术的不断革新和应用，探头频率不断提高，显示屏分辨率不断上升，图像后处理技术不断进步，浅表器官的显像得到了飞跃发展，更多的小病灶得以显示，显示病灶内微小结构的能力明显提高，日常工作中，我们甚至能够检出1mm的小结节，甚至可以判断其良恶性，堪比病理诊断；此外，能量多普勒(PDI)技术也在改进中，它使得血流信号的显示较彩色多普勒血流图更加敏感，很少依赖角度，已能兼顾反映血流方向及完整地显示血管走行，给我们进一步提供了研究肿瘤血管的可能性。目前，国内外超声学者已在不断的探索中总结了一些鉴别甲状腺良恶性病变的经验，大量的研究表明，甲状腺肿块病理类型复杂，声像图表现也呈多样性，且同一患者，甲状腺肿块可为多种来源超声影像表现反映了病变组织的病理学改变，，甲状腺结节的声像图表现与病理改变之间的关系也一直是学者们讨论的问题。第一部分甲状腺癌声像图特征分析目的深入研究甲状腺病变的二维图像特征、血流分布情况及各项血流参数，对照病理结果，对甲状腺超声诊断的声像图特征进行进一步分析，筛选出鉴别诊断力强的指标，供临床应用。资料与方法本研究选择2012年3月~2013年12月因甲状腺结节在本院手术的患者201例共226个甲状腺结节。对226个甲状腺结节的各项声像图表现进行单因素分析，筛选出与诊断恶性肿瘤相关的因素，包括：结果显示，对诊断甲状腺癌有意义的声像图表现有边界模糊、纵横比＞1、低回声、钙化、后方衰减及颈部淋巴结肿大。之后进行Logistic多因素回归分析。结果226个甲状腺结节的超声表现：①226例患者经术后病理证实，确定为良性59例，包括结节性甲状腺肿20例，甲状腺腺瘤49例；甲状腺癌167例，包括乳头状癌131例，滤泡癌23例，髓样癌7例，未分化癌4例，转移癌1例，淋巴瘤1例。与手术、病理结果对照，超声定位诊断符合率为100％，定性诊断符合率为83.6%(189/226)。超声的漏诊率为4.9%（11/226）、误诊率为11%(37/226)。其中12例滤甲状腺泡癌误诊为腺瘤，3个甲状腺癌误诊为结甲，11个微小型甲状腺癌因病灶小或结节性甲状腺肿掩盖而漏诊，6个结节性甲状腺肿误诊为腺瘤，1个甲状腺淋巴瘤误诊为未分化癌，4个髓样癌误诊为甲状腺乳头状癌。②超声诊断甲状腺癌的单因素分析：依据226个甲状腺结节的声像图表现，按照结节大小、数目、边界、有无声晕、结节内部回声、有无砂粒样钙化、后方回声衰减、颈部有无可疑淋巴结进行分组分析，用卡方检验作统计学分析。结果显示，对诊断甲状腺癌有意义的声像图表现有边界模糊、纵横比＞1、低回声、钙化、后方衰减及颈部淋巴结肿大。③经单因素分析后，选出P0.05的因素进行多因素Logistic回归分析，结果显示，有统计学意义的超声表现指标为：边界不清、纵横比＞1、低回声、钙化及颈部淋巴结肿大。结论 1.经Logistic多因素相关回归分析显示，低回声、钙化、边界模糊、颈部可疑淋巴结为诊断甲状腺癌的主要依据。 2.彩色多普勒超声对甲状腺良恶性结节的鉴别诊断具有重要意义，能为临床诊断及治疗提供准确信息。第二部分钙化在甲状腺癌超声诊断中的价值目的本研究旨在通过分析不同分型钙化与甲状腺结节的关系，探讨钙化在甲状腺结节超声诊断中的应用价值。方法选择2012年3月~2013年12月因甲状腺结节在本院手术的患者201例共226个甲状腺结节。所有患者术前均行彩色多普勒超声检查，二维超声重点观察结节内钙化灶的数目、形态、大小、分布。将钙化模式分为定Ⅰ型微小点状钙化，Ⅱ型粗钙化，Ⅲ型周边钙化三类。采用卡方检验比较甲状腺恶性结节与甲状腺良性结节的钙化率差异，比较I型、Ⅱ型、Ⅲ型钙化在甲状腺良恶性结节中的发生率差异。结果226个甲状腺结节经术后病理证实，确定为良性59例，包括结节性甲状腺肿20例，甲状腺腺瘤39例；甲状腺癌167例。总体钙化发生率50.44%（114/226）,其中167甲状腺恶性结节的钙化率为59.88%（100/167），59个甲状腺良性结节的钙化率23.72%（14/59），具有显著性统计学差异意义（χ2=35.216，P＜0.01）。Ⅰ型微小点状钙化在甲状腺恶性结节中的发生率为52.69%（88/167），高于其在甲状腺良性结节中的发生率5%（3/59），且差异有显著性统计学意义（χ2=39.523，P＜0.01）；Ⅱ型粗钙化在甲状腺良恶性结节中的发生率差异无统计学意义[4.79%（8/167）vs5.08%（3/59），χ2=7.216，P＞0.05]；Ⅲ型周边钙化在甲状腺良性结节中的发生率为8.47%（5/59），高于其在甲状腺恶性结节中的发生率4.19%（7/167），但差异无统计学意义（χ2=11.581，P＞0.05）。结论甲状腺结节恶性病变相对于良性病变更容易出现钙化，不同类型的钙化均存在一定恶性风险，对甲状腺良恶性结节的鉴别诊断有一定的参考价值。
[Abstract]:background
In recent years, the incidence of thyroid cancer is increasing year by year. It is the most common endocrine tumor, and it has become the most common malignant tumor in women. Thyroid cancer accounts for about 1%~2% of the malignant tumor of the whole body, and 5% to 10% of thyroid nodules are found to be thyroid cancer. Differentiated thyroid cancer accounts for 90% of all thyroid cancers. Papillary thyroid carcinoma (PTC) and follicular carcinoma. In recent years, the statistical data from China show that the incidence of PTC is increasing year by year. Therefore, the differential diagnosis of thyroid nodules is a key issue of clinical concern. At present, there are many methods of examination of thyroid diseases. Imaging examinations include ultrasound examination, radionuclide scan, CT, NMR In recent years, with the continuous innovation and application of the ultrasonic imaging technology, with the continuous improvement and application of ultrasonic imaging technology, the frequency of the probe is increasing, the resolution of the display screen is rising, the image post-processing technology is progressing, the imaging of the superficial organs has been leaps and bounds, and more small foci are displayed, and the micro nodules in the focus are shown. In the daily work, we can even detect the small nodules of 1mm, even to determine its benign and malignant, comparable to the pathological diagnosis; in addition, the energy Doppler (PDI) technology is also improved, which makes the display of the blood flow signal more sensitive than the color Doppler flow map, and is less dependent on the angle, which has been able to reflect the blood flow. We have further provided us with the possibility of studying the tumor vessels. At present, the scholars at home and abroad have summarized some experience in the differential diagnosis of thyroid benign and malignant lesions. A large number of studies have shown that the pathological type of the thyroid gland is complex and the image of the thyroid is diverse, and the same disease is the same. The thyroid mass can reflect the pathological changes of the pathological tissue for various sources of ultrasound, and the relationship between the ultrasonographic representation of the thyroid nodules and the pathological changes has been a problem that has been discussed by the scholars.
Analysis of ultrasonographic features of thyroid carcinoma in the first part
Objective to study the two-dimensional image characteristics of thyroid diseases, the distribution of blood flow and the parameters of blood flow, and to further analyze the ultrasonographic features of thyroid ultrasound diagnosis by comparing the pathological results, and to screen out the indicators of strong differential diagnosis for clinical application.
Materials and methods this study selected 226 thyroid nodules in 201 patients with thyroid nodules in our hospital in March 2012 ~2013. A single factor analysis of the ultrasonographic features of 226 thyroid nodules was carried out to screen out factors associated with the diagnosis of malignant tumors, including: the results showed that it was meaningful for the diagnosis of thyroid cancer. The sonograms showed blurred boundaries, aspect ratio > 1, hypoechoic, calcification, posterior attenuation and cervical lymph node enlargement. Logistic regression analysis was performed.
Results the ultrasonographic findings of 226 thyroid nodules: (1) 226 patients confirmed by postoperative pathology confirmed that 59 cases were benign, including 20 cases of nodular goiter, 49 thyroid adenoma, 167 thyroid carcinoma, 131 cases of papillary carcinoma, 23 follicular carcinoma, 7 cases of medullary carcinoma, 4 undifferentiated carcinoma, 1 metastatic carcinoma, 1 cases of lymphoma, operation, pathological results. The diagnostic coincidence rate of ultrasonic localization was 100%, the diagnostic coincidence rate of qualitative diagnosis was 83.6% (189/226). The rate of missed diagnosis was 4.9% (11/226) and the misdiagnosis rate was 11% (37/226). 12 cases of thyroid carcinoma were misdiagnosed as adenoma, 3 thyroid cancer was misdiagnosed as nail, and 11 small thyroid adenocarcinoma was missed because of small or nodular goiter. 6 A nodular goiter was misdiagnosed as adenoma, 1 thyroid lymphoma was misdiagnosed as undifferentiated carcinoma and 4 medullary carcinomas were misdiagnosed as papillary thyroid carcinoma. (2) single factor analysis of thyroid carcinoma diagnosed by ultrasonography: according to the image of 226 thyroid nodules, according to the size, number, boundary, nonacoustic halo, internal echo of nodules, and no sand particles Sample calcification, posterior echo attenuation, or not suspicious lymph nodes in the neck were analyzed, and statistical analysis was performed with chi square test. The results showed that the significance of the diagnosis of thyroid cancer was blurred by the boundary, the longitudinal and transverse ratio > 1, the low echo, the calcification, the posterior attenuation and the cervical lymph node enlargement. 3. After single factor analysis, the factors of P0.05 were selected. The results of multifactor Logistic regression analysis showed that the statistically significant ultrasonographic indicators were unclear boundary, vertical and horizontal ratio > 1, hypoechoic, calcification, and cervical lymph node enlargement.
conclusion
1. multivariate regression analysis of Logistic showed that low echo, calcification, blurred border and suspicious cervical lymph nodes were the main basis for the diagnosis of thyroid cancer.
2. color Doppler ultrasound is of great significance in the differential diagnosis of benign and malignant thyroid nodules. It can provide accurate information for clinical diagnosis and treatment.
The second part of the value of calcification in ultrasound diagnosis of thyroid carcinoma
Objective the purpose of this study was to evaluate the diagnostic value of calcification in thyroid nodules by analyzing the relationship between different types of calcification and thyroid nodules.
Methods 226 thyroid nodules were selected in 201 patients with thyroid nodules in December ~2013 March 2012. All patients underwent color Doppler ultrasonography before operation. The number, shape, size and distribution of calcified focal nodules were observed by two-dimensional ultrasound. The calcification mode was divided into type I microcalcification and type II coarse calcification. Three types of type III peripheral calcification. The calcification rates of thyroid malignant nodules and thyroid benign nodules were compared by chi square test. The difference in the incidence of type I, type II and type III calcification in benign and malignant thyroid nodules was compared.
Results 226 thyroid nodules were confirmed by postoperative pathology, and 59 cases were confirmed as benign, including 20 cases of nodular goiter, 39 thyroid adenoma, 167 thyroid carcinoma, 50.44% (114/226), 167 malignant nodule calcification rate 59.88% (100/167), 59 thyroid benign nodule calcification rate 23.72% (14/59), with 59 thyroid nodules 23.72% (14/59). There was significant statistical difference (x 2=35.216, P < 0.01). The incidence of type I microcalcification in thyroid malignant nodules was 52.69% (88/167), higher than that in benign thyroid nodules (5% (3/59)), and the difference was statistically significant (x 2= 39.523, P < 0.01); type II coarse calcification in benign and malignant thyroid nodules. There was no statistically significant difference in the incidence of [4.79% (8/167) vs5.08% (3/59), X 2=7.216, P > 0.05], and the incidence of type III peripheral calcification in benign thyroid nodules was 8.47% (5/59), higher than that in the malignant thyroid nodules (4.19% (7/167)), but the difference was not statistically significant (x 2=11.581, P > 0.05).
Conclusion the malignant lesions of thyroid nodules are more prone to calcification than benign lesions, and there are certain malignant risks in different types of calcification. It is of certain reference value for the differential diagnosis of benign and malignant thyroid nodules.
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R736.1;R445.1

【参考文献】